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PCOS, Weight and IVF

I am not sure this is the right place to post this, but here goes.

My wife has PCOS, and went through the process of IVF four years ago. As part of the process, she went on a low carb diet and lost a good deal of weight. Fertilization and implantation were a success, but sadly, the pregnancy miscarried at four months. After which, my wife just could not face a diet again. She put the weight back, and then some, and we both agree that pushing her to lose the weight again would be counterproductive. She still tries to eat less carbs, though, and more fiber and protein.

When we were ready to start the process again, we were told that there was no way they would do IVF on my wife again till she lost weight. They even suggested a lapband or something similar. After talking a lot about this, we decided that the doctor, however well meaning, showed no sensitivity for my wife's weight. But we have been unable to find another IVF clinic that will tell us she's welcome.

So I have a few questions:

1. How risky is it to my wife to undergo IVF right now? It seems that the consensus is that the anesthesia could have bad side effects, but I've seen it suggested that the labs just don't want to take a chance on an IVF that will lower the "success rate."

2. Do any IVF clinics ever do an implantation in a hospital, so that they can manage things better? It seems that this would be a better approach than a clinic in an office.

3. It is essential for her to lose weight? It sure feels like a lot of fat women have babies. I get that she has PCOS, but I can't help but feel like what we are seeing is as much discrimination against the fat as anything else.

Any advice you can provide in this matter would be greatly appreciated.

Weight gain can cause various problems when performing IVF. Most IVF procedures are performed in the IVF clinic, which is often not attached to a hospital. Anesthesia for the egg retrieval is usually safe, but as women gain weight, breathing difficulties arise, and an anesthesiologist may not have the means to care for significant breathing abnormalities in an outpatient setting. For anesthesia alone, many clinics have hard and fast limits above which the procedure cannot be performed.

Additionally, as weight increases the ovaries become more difficult to access during the egg retrieval process. Usually the ovaries are down low in the pelvis and are easy to see, making the passage of a large needle into the ovary more simple. But if the ovaries are not down low in the pelvis, which is often the case as weight increases, then we cannot pass our large needles into the ovary safely. And if our needles pass into bowel or blood vessels, major complications can arise.

Some studies have also shown that medication needs increase with weight, and that overall likelihoods of success may be lower as a woman's BMI increases. This is the body mass index, which takes into consideration height as well as weight. To have th ebest possible chance to conceive, weight loss is always encouraged.

So the egg retrieval process can be much more risky as weight increases. And the eggs need to be retrieved close to the lab, to have the best outcome. We always have to assess the risks of what we do, but there are also many other risks, especially during the pregnancy, that are increased with body weight. Many overweight women conceive easily--but when you have limited opportunities to conceive with help (whether that is due to financial limitations or other), it is best to do all that can be done to increase your likelihood of success if possible, including whatever can be done (including surgery) to address weight issues.